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Home My WebLink About6392-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.1.7.2 ...... Date .............. ~ ...... -3l).., 19..7'3 THIS CERTIFIES that the building located at . .Souml .l~eaQh. Drlv~ ...... Street Map No.¢apt. K:Ldd. E~ock No ........... Lot No.b,3 ....... .Ma.t.t.~,~.. N.,.~. ? ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... l/aZ~h .... ~., 19.7',~ pursuant to which Building Permit No...639~ dated ........... NAI' ..... 7.., 19.~3., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .l~z';Lvate. ane. £am$1~'. dwelling ...................................... The certificate is issued to . A,OFpl~m. &..Chax'les. Realt~ .... 0wnex' ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... N. :.R.: .......................... UNDERWRITERS CERTIFICATE No...~...~.~..3.~'...~.~1'....~....~ 97.3. ...................... HOUSE NUMBER... 7'/,~.~ ...... Street .....BOlllld. lSo&Qh. R~2&(I ......................... Building Inspector TOWN O~ SOUTSOL~ BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6392 Z Permission is hereby granted to: ......... ~le..itc~& ........................................... at premises located at ....~..t~ ....... .g.&j~.t,..J~:Lcl,.. ~,~:~,~:~,,e.S ............................................................ ................................... ~./.Ji...tig.~ ..~J~J~. ~r;Lv.e ............ ~,t,~.t,~el~ ......................................... pursuant to application dated .................. .~,aa~o~ ....... .~ ....... ; ....... , 19..~..~., and approved by the Building In.~:tor. Fee $.~. ~..?...0~... ............ Building Inspector / APPMC, ATIO~ FOR BUILDING FERMIT Dote ................... ,~.., ..... , ~.-~....~. I~RU~I~S a. This a~i~tion mu~ ~ ~m~lately filled in by ~wri~r or in ink and submi~ed in tri~li~te to ~ ~ildi~ I~or, wi 3 ~ of ~m, ~ plot ~an to scale. Fee ~d~ to ~u~. .,.b..Plqt ~L~?~tion ,of lot ~d of ~ildi~ on p~mi,s,.relationsh~p g~ a ~~i~ of I~t ~ ~o~ mu~ ~ dr~n on d~ ~t~ :s ~ ot tins appu~tton. ~ ~ ~ ~is~i~ti~ ~ not d. U~n ~a of ~il ~i~tion, ~e Building In~or will issue a Building ~rmit to t~ ~mim waU~ for ins~i~ throu~t t~ wo~. e. ~ ~i~ ~1 ~ ~pi~ or u~ in whole or in ~ ~ ~ ~ildi~ Ins~or. APPLICATION IS HEREBY MADE tCl the Building Dei~rtment for the is~ee of a Building Permit pursuant to the Building Zo~ Ordinance of the Town of $outhold, Suffolk Co~lhty, New Yo~k,~t other applicable Law~, Ordinance~ or Regulations, for the con~tmction ~ buildlng~, addltiom or alterations, or for removal or demolitio~, m ~erein d~crlbed. ~ epplieant agrees to comply with MI al~licable law ordinanca~, building code, housing code. and regulations, and to admit authorized iosl~ctors on~rami~e~ end in building~ for nace~ary in~ectiom. · (Signature of applicant, or name, if a corporation) :' ......... ..'..... (Address of applicant) /V- State whether applicant is owner, levee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ~-~,./z.~,~L ~,,/~'~t~_~'~/~ ................................................ Name of owner Of premises .... (~-.~......~- ....................... ~ ...... ~ ...................... ' ,,~.; ,/~., .............................................. If applicant is a cprpo,ate, ligr~lure o/d¥!y.authori~ed/-------- offi, cen j (Name 'i · Builder's License No .......................................................... Plumber's License No Electrician's License No ................. Other Trade's License No ................................................... 1. Location of and on which proposed wor~will be done· Map No...~.'...~.-/..~.~.....~-- .~..~..~.~-~Lot No....~... ................. Street and Number ......?...~..~....'~..s~- ...... ~..~...-..~.. ...... ~.-.~.../.'~..~....'...' ...................... r ................... ' ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propomd construction: · · , ........................... a. Ex,sting use and occupancy .................. .~:;..~..~ ................................. b. Intended use and occupancy .... ..~..(. ..~ ........ : ..................................... 3. Nature of work (check which apoliceble): New Building ....................... Addition ....... Alterati .... Repair ......................... Removal ......................... Demolition .................. ...... Other Work .................................... (Description) ,. E.i~ts,,~ ..~..q..~...= ......... ~, ..... ~'~..~., .................................................................................. (to be ~id on filing this ai3~lication) 5. If'dwelling, number of dwelling units ..... / ........ Number of dwelling unitson each floor ............ /.. .......................... If garage, number of cars ~/o/~/~__ - 6. If business, commemial or mixed occuoancv, specify natur~ and extent of each type of use ........... ~..f~ ................... 7, Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... ' Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear'J ........................................ Depth ............................................. Height ....................................... :; Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ... ....................... ~.. Depth ................................. Height.... ................................ ... . . ....... . Number of Stories ............ 9. Size of lot: Front ............... , ...................... ~l~ear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ..~?z~......~......~'~ ............................... 11. Zone or usa district in which 13remims are situated ............ ~....~....~./:..~.~..~:.../.~....~r... ................................................. 12. Does oropceed construction Violate any zoning law, ordinance or regulation: ......... ~,,/~'....O.. .......................................... 13. Will lot be re~'eded ..... .~.~ .................... _ Will excess fill.be removed from ~l~S: [ ] Yes 14. Name of Owner of premises ~ ' ~ ..?.,,..~.~,...~,,....P~:,~:~ ~...~c .~.~..... ........... :.~ ............... .~.. Name of Architect ................................................................................................. ,am.o, ...... -.--.....- PLOT DIAGRAM Locate c..learly.and di~nct.ly all buildings, ~ exiKing or propoa~l, and indicats all ~ d~e~om f~:. ~ ~o~ lin~. Gi~ ~t ~d bilk ~m~ or ~ption ~Ming to ~, ~d ~ ~ ~a~s a~ i~ ~:/~: interi~ ~ co~ lot. STATE OF NEW YORK~.,.~/j / ) ..................... ....... being duly sworn, deooses and savs that he is the applicant above H~ ~, ,be ................... : ................ :....~.~ ................................................................... ( ~n~tor, ~t, c~mte o~, ~ } of ~id ow~r 0r. ow~, ,and is duly authoH~ to ~orm or ~ ~rfor~d t~ ~ w~ ~ ~ ~e ~ fi~ this a~li:tion; ~ all sta~n~ contam~ ~-t~s a~i~ are, tr~ to t~ of his kho~ a~ ~lief~ a~ ~ Wo~ will ~ ~or~ in ~ ~nmr ~t fo~h in t~ ap~i~tion fil~ ~mw;th. Nota~ Pub c - ~ ~'- ~ ...................................................................... ~unW ........................................................ :_.~.~ ........................... FORM NO. tS TOWN OF SOUTHOLD Buildin9 Delta J~ment Town Clerks Office Southold, N. ¥, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink. and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings. AAultiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ................................................ New Building .................... Old or Pre-existing Building ............ ~.... Vacant Land ............................ Location Of Property .... .,~'.?.?.......~.....~....~..~. ...... ..~./.~......~..?...~..~.~.....~....~..~.......~...~.~..~.~..~.~....~'.~......~.~-- Owner Or Owners Of Property ¥1 ~ C \c ~ ~! ~ (~-~ -~ Subdivision ..C~..?...~?..~.......~...~..~...~.......~.~....%~....~.....Lot No..~.....~...... Block No ............. House No ............. ~ ') 3'~ I' n .................................................................. Permit Dote Of Perm*t ..... I....! ........ ^pp,cat Health Dept. Approval .... :;....1..:.;.; .......................... Labor Dept. Approval ...............,. ............................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .................................... ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meets all applicable codes and regulations. Applicant .......l~.....~....~........~..~', .?~..c'....*~....3.....~.......,C.~..~......(~...'. ...................... Sworn to before me this ~ (stamp or seal) ~ ~'/ 4,